# Assessment of Pregnant Women’s Knowledge, Attitudes, and Habits Regarding Oral Health: Development and Validation of a Measurement Instrument

## TL;DR

This study developed and validated a questionnaire to assess pregnant women's oral health knowledge, attitudes, and habits in Croatia, aiming to improve public health interventions.

## Contribution

The study introduces a validated psychometric instrument for assessing oral health in pregnant women, following COSMIN guidelines.

## Key findings

- The questionnaire showed a six-factor structure with acceptable to strong factor loadings.
- The instrument demonstrated good internal consistency and excellent test-retest reliability.
- Knowledge about oral health was found to be independent of attitudes and practices during pregnancy.

## Abstract

Public health relevance—How does this work relate to a public health issue?
Lack of validated psychometric instruments for reliably assessing knowledge, attitudes, and oral hygiene practices in pregnant women.Lack of education of pregnant women about oral health.

Lack of validated psychometric instruments for reliably assessing knowledge, attitudes, and oral hygiene practices in pregnant women.

Lack of education of pregnant women about oral health.

Public health significance—Why is this work of significance to public health?
Validation of a comprehensive instrument for knowledge, attitudes, and oral hygiene practices in pregnant women based on Standards for the selection of health Measurement Instruments (COSMIN) guidelines.Validated questionnaire is a reliable public health tool for systematic data collection, supporting targeted educational interventions to prevent caries and promote oral health among pregnant women.

Validation of a comprehensive instrument for knowledge, attitudes, and oral hygiene practices in pregnant women based on Standards for the selection of health Measurement Instruments (COSMIN) guidelines.

Validated questionnaire is a reliable public health tool for systematic data collection, supporting targeted educational interventions to prevent caries and promote oral health among pregnant women.

Public health implications—What are the key implications or messages for practitioners, policy makers and/or researchers in public health?
The validated instrument enables systematic data collection and evaluation of the effectiveness of specifically designed health-educational interventions to improve oral health in pregnant women.The integration of the comprehensive instrument into routine gynecological and dental prenatal care can facilitate the systematic identification of at-risk populations and the design of targeted educational programs.

The validated instrument enables systematic data collection and evaluation of the effectiveness of specifically designed health-educational interventions to improve oral health in pregnant women.

The integration of the comprehensive instrument into routine gynecological and dental prenatal care can facilitate the systematic identification of at-risk populations and the design of targeted educational programs.

Oral health during pregnancy is a critical factor in preventing caries in both mothers and children. Croatia currently lacks validated psychometric instruments for reliably assessing knowledge, attitudes, and oral hygiene practices in the general population. This study aimed to develop and provide initial psychometric evidence for a comprehensive instrument for this purpose in Croatia, with potential relevance for future cross-cultural adaptation. Following Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) guidelines, an initial item pool was generated through literature review and expert consultation. The study was conducted from May 2024 to February 2025 in primary healthcare settings across Primorje-Gorski Kotar County (PGC). The validation study included 319 pregnant women. Exploratory factor analysis (EFA) revealed a six-factor structure with acceptable to strong factor loadings (ranging from 0.423 to 0.984). The instrument showed acceptable to good internal consistency (Cronbach’s α = 0.61–0.87) and excellent test–retest reliability (Pearson r = 0.993). Results indicated that knowledge about oral health was independent of attitudes and practices during pregnancy. Regression analyses were exploratory and did not provide evidence of predictive validity at this stage, suggesting that additional contextual and psychosocial factors should be considered in future modelling. The present study provides initial psychometric evidence supporting the proposed structure and reliability of the instrument; however, further confirmatory and longitudinal validation studies are required before broader implementation and generalization can be fully justified.